Spring 2002
Geriatric Assessment: Helping the Whole Family

In traditional Korean culture, according to experts in Korean studies, the man is absolutely the head of the family. He is the one who makes the decisions and sets the course. His wife and children look to him for strong leadership.

But Hyunsook Kim's husband of nearly half a century was beginning to show signs of memory loss and confusion. Wook Kim's personality changed; he became anxious, argumentative, and angry. He would get lost; he would forget things. Mrs. Kim didn't know what to do. And the person she normally would have turned to for advice—her husband—was the source of her worries.

Fortunately, the staff at the Baldwin Senior Center in Stratford did know what to do. Elizabeth Paris, social services coordinator at the Baldwin Center, suggested that the Kims see geriatrician Beata Skudlarska, MD, at Bridgeport Hospital's outpatient geriatrics program.

What Is Geriatrics?
Geriatrics is medical care that is dedicated to older adults. A geriatrician—a physician specializing in geriatric care—has a full understanding of the wide range of problems that older adults can have. A geriatrician is trained to watch for the ways in which these problems can combine to prevent an older person from enjoying the fullest life possible.

What Is a Geriatric Assessment?
A geriatric assessment can reveal the reasons for many problems that affect some older people. These can include depression, memory loss, behavior problems, frequent falls, dizzy spells, problems with urination, side effects from medicines, and other difficulties.

Mr. Kim's assessment, which took about 1.5 hours, included:

  • Gathering information to understand the personal and family medical history.
  • A full physical exam to look for any underlying physical causes.
  • Tests and screenings to evaluate him physically, emotionally, and mentally.
  • A questionnaire for family members to help identify problems and solutions.
  • A review of all drugs and supplements Mr. Kim was taking.

Mrs. Kim, Mr. Kim, and their younger son, William, all came to the appointment with Dr. Skudlarska. As the doctor assessed Mr. Kim, she saw that Mrs. Kim was under a lot of stress. "During our first meeting, Mrs. Kim spent 20 of the 40 minutes weeping," she says.

Dr. Skudlarska's assessment showed that Mr. Kim was in the early stages of memory loss—a condition affecting many, but certainly not all, older adults. But his most immediate problem—the one causing his anger and anxiety—was depression. The memory loss was a progressive condition that wouldn't go away. But his depression could be treated. So the first action Dr. Skudlarska took was to prescribe Celexa, a common anti-depressant.

Dr. Skudlarska could see that Mrs. Kim herself was under a great deal of stress and anxiety. She suggested that Mrs. Kim talk to her personal physician, Lucia Chou, MD, to see if medications for depression might help her as well. Dr. Chou prescribed Paxil, another common anti-depressant, for Mrs. Kim.

Dr. Skudlarska also explained to Mrs. Kim that when her husband got angry and shouted at her, he didn't always realize what he was doing, and that she needed to stand up for herself. Realizing this helped Mrs. Kim understand that it was okay for her to take a more decisive role in their family life.

Things are much happier at the Kims' house now. Mrs. Kim is more hopeful, and Mr. Kim is less anxious. "He takes Celexa, I take Paxil, and we stop fighting," Mrs. Kim says, laughing.

William Covey, MD, Mr. Kim's personal physician, appreciates the contributions Dr. Skudlarska can make to his patients' care. "As a specialist in the problems of older adults, Dr. Skudlarska is a great asset to medical care in our community," he says. "Working with Dr. Skudlarska, I can give my older patients the special care they may need."

For an appointment for geriatric assessment, or for more information about geriatric assessment, the REACH Day Center for Adults, or other REACH programs for older adults, please call 203-384-3754.

Other Sources of Help and Information
Beyond assessing Mr. Kim’s mental and physical problems, Dr. Skudlarska also talked to the Kims about their many other choices, and made some important suggestions. William now has his father’s legal power of attorney in case any major decisions must be made. Dr. Skudlarska also provided written information on the many programs that are available to help families like the Kims. These include Bridgeport Hospital’s REACH Day Center for Adults, REACH outpatient mental health programs, and the hospital’s CARE program, which puts seniors in touch with helpful community resources. "Just having this information helps to relieve the stress of families who are going through this," says Dr. Skudlarska.